- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $3,548.13 / $6,760.83
| Facility | | $331.13 | $3,548.13 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $1,122.02
| Facility | 50 | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $269.15 / $794.33
| Professional | | $128.82 | $269.15 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $398.11 / $1,000.00 / $1,479.11
| Professional | 50 | $398.11 | $1,000.00 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $389.05 / $602.56
| Professional | | $316.23 | $389.05 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $316.23 / $537.03
| Professional | | $151.36 | $316.23 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $501.19 / $1,621.81
| Facility | | $275.42 | $501.19 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $363.08 / $1,023.29
| Professional | | $223.87 | $363.08 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $436.52 / $549.54
| Professional | | $302.00 | $436.52 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $398.11 / $549.54
| Professional | | $257.04 | $398.11 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $426.58 / $537.03
| Professional | | $3.98 | $426.58 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,412.54 / $2,344.23
| Facility | | $776.25 | $1,412.54 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $251.19 / $501.19
| Professional | | $141.25 | $251.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $302.00 / $446.68
| Professional | | $257.04 | $302.00 | $446.68 |